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W. APPLICATION FOR SANITATION. PERMIT ' Permit No. r {Complete in Duplicate) 621 jr Date Issued ._.---r - -- Application is hereby ma e o the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made i c mpliance with County Ordinance No. 549. JOBADDRESS AND LOCATION--------- 4 2 E• Elvin------------------------------------------------------------------------------••---------------------------------- Owner's Name-----.'-- 1y n__V4r. ThO lr'1.5.,:{c4c----_B'-11-.h--------------------------------- ------------------------------------ Phone-----4-,5-0 ------------- Address---------------same----------------- Contractor's Name-•------- .-------------------------•------------------- ------------------ ------------------------------------- Phone........5--3-9-x5-r5---------- r . Installation will serve: 'Residence a "Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --]__ Number of bedrooms __2___ Number of baths .-I---_ Lot size -------------------------------------------------------- ---- r Water Supply: Public-system ER Community system ❑ Private ❑ Depth to Wates Table . 5_ ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: Yes ❑ No ❑x New Construction: 'Yes Ej No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or-cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well _--TIO_-----Distance from foundation-_1.0..........Material----1_---ce �entt b.r_tc_k------ [3 No. of compartments-..----�_---------- __Size-- 6---X4- 5 q --x4 Liquid depth----- ---&-- ------.Capacity------8,00-------- } Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- A ❑ Number of lines----------------------.------------Length of each line----------------------- ..Width of trench----------------------------------- Type of filter material--_--- - ------.Depth of filter material---------------------_Total length_-------------------_-----------_.--- -- 1 I 'L �3 Seepage Pit: Distance to nearest well-.Tlo--------------Dista undation----_-_jQ!---_.Distance to nearest lot line----.- 0_!_ Number of pits-.-.--_--1-----------Lining materi I----b��Size; Diameter------3-1--------.---.Depth----------2Q................. � Cesspool: Distance from nearest well-----------------Distance r foundation--------------------Lining material-----------------:--.--__--_---._-.' Size: Diameter------- -----------------------De th---------------------------------------------------Liquid Capacity gals. Privy: Distance from rearest dell----- -----------------_-----_---.--.----------Distance from nearest building.----.-_-----.----_--_._--.--.._-..-. ❑ Distance to nearest lot line -------------------------------------------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):-------------------new,------------------------------------------------- - ------------------------------------------------------•-------------------------------------••----------------------------...-------------------------------------------------------••----....---•---------------------------- x I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i (Signed)------------Delta InC ----------------- - -------- --------�-----------------------------------------------------------------------(Owner and/or Contractor) By:............ Parr Wax't�Y� !U; ---------------------------------------------(Title)-----Gen...---D1gr.--------------------------------- s (Plot plan, showing size of lot, location of sysltjm in relation to wells, buildings, etc., can be placed on reverse side). I 1`01 DEPARTMENT USE ONLY AAPPLICATION ACCEPTED BY------------ f ------------=------------------------------------- DATE----. 1, ' �—��------------------------ REVIEWED BY------------------------- -------------- ----- -------------------------------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE..----------------------------------= ------------- Alterationsand/or recommendations:----------------------------= ------- - ------------------------------------------------ ------------------------------------•-------------------------- -------------------------------------------------------------- -------- ------------------------------------------------------- ---------------------------------------------------- ------------------------------- { ------------------•--•-••--•---------------.-.-.-.-...------------------------------------- ------------------•- -----------------------....------•---•----------------------------------------------....------ a 3 I FINAL INSPECTION BY:----- DY � da!®�1 ------ ------ Date...-_�------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Pevised W-2100